| Part 1Aims This study aimed to compare the differences in 30-day mortality and the potential causes of death between the STEMI patients who did not take statins before and after hospitalization and the STEMI patients who took statins only after hospitalization.Methods We collected data from China Acute Myocardial Infarction(CAMI)Registry from 2013 to 2017 and there were 33001 ST-segment Elevation Myocardial Infarction(STEMI)patients.Among them,of 20009 patients included for analysis,1169 patients were assigned to Group A(did not take statins before and after hospitalization)and 18840 patients were assigned to Group B(took statins only after hospitalization).The propensity score model and Logistics regression were used for statistical analysis.The primary outcomes were 30-day major adverse cardiovascular and cerebrovascular events(MACCE),a composite of all-cause death,myocardial infarction(MI)or stroke.Results At 30-day follow-up,the incidence of MACCE was higher in the Group A than that in the Group B(31.5%vs 9.7%,P<0.0001).Nonetheless,among MACCE,significant statistical difference between the groups did not exist in MI(1.4%vs 1.3%,P=0.8307).After propensity score matching,the differences in the incidence of MACCE between the two groups were only attributed to the differences in all-cause death(25.7%vs 9.8%,P<0.0001).As regards in-hospital major complications,Group A had higher proportion of malignant arrhythmias(12.6%vs 8.9%,P=0.0008)and in-hospital cardiac arrest(13.5%vs 5.2%,P<0.0001).Conclusions Statins reduce 30-day mortality of STEMI patients.Underlying mechanisms may be associated with the reduction in malignant arrhythmias or other unclear effects more than reducing well-recognized cardiovascular event like MI.Part 2Aims This study aimed to compare the differences in 30-day mortality and the potential causes of death between the STEMI patients who did not take statins before and after hospitalization and the STEMI patients who took the statins immediately after they was diagnosed and continued taking the statins after they was hospitalized.Methods We collected data from China Acute Myocardial Infarction(CAMI)Registry from 2013 to 2017 and there were 33001 ST-segment Elevation Myocardial Infarction(STEMI)patients.Among them,of 7964 patients included for analysis,1169 patients were assigned to Group A(did not take statins before and after hospitalization)and 6795 patients were assigned to Group B(took the statins immediately after they was diagnosed and continued taking the statins after they was hospitalized).The propensity score model and Logistics regression were used for statistical analysis.The primary outcomes were 30-day major adverse cardiovascular and cerebrovascular events(MACCE),a composite of all-cause death,myocardial infarction(MI)or stroke.Results At 30-day follow-up,the incidence of MACCE was higher in the Group A than that in the Group B(31.5%vs 9.2%,P<0.0001).Nonetheless,among MACCE,significant statistical difference between the groups did not exist in the incidence of MI(1.4%vs 1.2%,P=0.6476).After propensity score matching,differences in the incidence of MI between the groups still were not significant(1.3%vs 1.4%,P=0.8565).As regards in-hospital major complications,Group A had higher proportion of in-hospital cardiogenic shock(16.4%vs 11.4%,P=0.0007)and cardiac arrest(13.8%vs 7.0%,P<0.0001).Conclusions Statins reduce 30-day cardiovascular mortality of STEMI patients.Underlying mechanisms may be associated with the reduction in in-hospital cardiogenic shock or other unclear effects more than reducing well-recognized cardiovascular event like MI.Part 3Aims This study aimed to compare the differences in 30-day mortality and the potential causes of death between the STEMI patients who did not take statins before and after hospitalization and the STEMI patients who took statins both before and after hospitalization.Methods We collected data from China Acute Myocardial Infarction(CAMI)Registry from 2013 to 2017 and there were 33001 ST-segment Elevation Myocardial Infarction(STEMI)patients.Among them,of 1466 patients included for analysis,1169 patients were assigned to Group A(did not take statins before and after hospitalization)and 297 patients were assigned to Group B(took statins both before and after hospitalization).The propensity score model and Logistics regression were used for statistical analysis.The primary outcomes were 30-day major adverse cardiovascular and cerebrovascular events(MACCE),a composite of all-cause death,myocardial infarction(MI)or stroke.Results At 30-day follow-up,the incidence of MACCE was higher in the Group A than that in the Group B(31.5%vs 6.4%,P<0.0001).Nonetheless,among MACCE,significant statistical difference between the groups only existed in the incidence of all-cause death(28.6%vs 2.0%,P<0.0001).After propensity score matching,analysis revealed similar results(MACCE:24.7%vs 4.5%,P<0.0001;all-cause death:21.1%vs 2.7%,P<0.0001).As regards in-hospital major complications,Group A had higher proportion of mechanical complications(4.9%vs 0.4%,p=0.0016),malignant arrhythmias(12.1%vs 4.0%,p=0.0014)and in-hospital cardiac arrest(11.7%vs 0.4%,P<0.0001).Conclusions Statins reduce 30-day mortality of STEMI patients.Underlying mechanisms may be associated with the reduction in mechanical complications,malignant arrhythmias or other unclear effects more than reducing accepted cardiovascular and cerebrovascular events including MI and stroke.Part 4Aims This article is to describe the initial usage patterns of statins intensity for patients with ST-segment elevation myocardial infarction(STEMI)in China,and to evaluate the correlation between statins intensities and the long-term prognosis of the STEMI patients.Methods From January 2013 to September 2014,a total of 14,713 STEMI patients enrolled in China Acute Myocardial Infarction(CAMI)Registry were included in this study.According to the initial type and dosage of statins during the hospitalization,the patients who took atorvastatin 40?80 mg or rosuvastatin 20 mg were assigned to high-intensity statins group and the patients who took other types and dosages of statins were assigned to moderate-intensity statins group.Subgroups analysis included emergency percutaneous coronary intervention(PCI)subgroup(n=6,202),thrombolysis subgroup(n=1,435),and conservative treatment subgroup(n=6,901).The primary endpoints were major adverse cardiovascular and cerebrovascular events(MACCE)of 24 months,a composite of all-cause death,myocardial infarction or stroke.Results 2,394(16.3%)STEMI patients were initially treated with high-intensity statins in this study.From 24-month follow-up,there were 264(11.0%)MACCE in the high-intensity statins group and 1,783(14.5%)MACCE in the moderate-intensity statins group.From subgroup analysis,only the conservative treatment subgroup revealed that the incidence of MACCE in the high-intensity statins group was significantly lower than the moderate-intensity statins group(15.4%vs 19.4%,P=0.0084).However,there was no statistical difference existing in emergency PCI subgroup(7.8%vs 8.7%,P>0.52)and conservative treatment subgroup(13.2%vs 13.3%,P>0.90).Multivariate Cox analysis showed that initial intensity of statins was not an independent factor for MACCE at 24-month follow-up(HR=1.037,95%CI:0.885-1.215,P=0.6513).The two statin usage strategies were also independent of long-term outcomes in patients receiving emergency PCI,thrombolysis,and conservative treatment.Conclusions In the real world,Chinese patients with STEMI were mainly treated with moderate-intensity statins initially.The intensity of statins was not associated with the risk of 24-month MACCE for the STEMI patients. |
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